How Much Does Assisted Living Cost?

Key Takeaways

• The average cost of assisted living in the United States is $4,500 per month, or $54,000 annually. The cost of assisted living varies depending on the type of community or facility, the state you live in, and the level of care you need.
• The base fee for room and board cited by most assisted living facilities does not include personal care services, which usually incur additional fees.
• People often pay for assisted living using a combination of personal savings, assets, and insurance benefits. Medicare and Medicaid can help with the cost of health care received in assisted living, but they will not cover room and board. Medicaid waivers may help a resident cover those costs, when used in conjunction with their income.

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As his mother’s needs increased, David Moore, a North Carolina resident who cares for his 80-year-old mother, worried it could become too challenging to keep her at home. But when he started researching assisted living options, he found it was hard to get clear answers about cost. When he did manage to get answers about monthly fees, the fees were much higher than he expected. While Moore wanted to find a facility with the best possible care, his mother’s financial resources were limited, so budget would have to be a big part of the assisted living conversation.

Moore is not alone in his search for assisted living or in his concern about the cost. In the NCOA Adviser Local Care Reviews Team’s 2023 survey, we asked 1,000 older adults and their caregivers about their search for senior living options. Nearly 70% of respondents cited cost as one of the most important factors in their search for assisted living. ^[1]Local Care Reviews Team survey. 1,000 respondents. Conducted using Pollfish. Launched March 2023. While safety concerns, cleanliness, and peace of mind came in above cost in terms of importance, the survey results pointed to the importance of finances in selecting senior living. Older adults and their care partners can’t ignore that assisted living often comes with a hefty price tag. But is it more or less affordable than other care options? And do you or your care partner have the resources to cover it?

Our Local Care Reviews Team team broke down the factors that influence the cost of assisted living and provided a comprehensive guide to monthly fees and how to cover them.

Why you can trust our expert review

Our Local Care Reviews Team works hard to provide clear, transparent information to older adults and their caregivers seeking senior living and home care. To provide you with the best possible information, we have spent more than 250 hours:

• Consulting with our advisory board, which consists of a certified care manager, a board-certified geropyschologist ⓘA geropyschologist is a psychologist who specializes in the needs and mental health of older adults., and a geriatric nurse practitioner
• Analyzing and synthesizing nationwide data from the Centers for Medicare & Medicaid Services (CMS) and the National Investment Center for Seniors Housing & Care (NIC)
• Analyzing and synthesizing state-specific data from government health regulatory agencies
• Surveying 1,000 older adults and their caregivers about their search for senior living and home care options
• Conducting a focus group with caregivers helping older adults find assisted living
• Mystery shopping dozens of brands and facilities associated with long-term care for older adults

How much does assisted living cost?

According to the Genworth 2021 Cost of Care Survey, the average monthly cost of assisted living is $4,500. This fee may increase due to the price of additional services, such as help with activities of daily living (ADLs) ⓘActivities of daily living, also called ADLs, are activities related to necessary personal care. These include bathing, dressing, toileting, eating, walking, and transferring in and out of a bed or chair., like bathing or dressing. ^[2]Genworth. 2021 Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html Because assisted living facilities are regulated on the state level, the cost and scope of services will vary widely based on where you live. For example, Genworth reported the average cost of assisted living in Florida is about $4,000 per month; in Oregon, it’s $5,045; and in Alaska, the average cost of assisted living is more than $6,000 per month.

Assisted living pricing structures

Our research found that most assisted living facilities provide residents a base fee for room and board and then add additional monthly fees based on the level of care each resident needs. In most cases, the more care you or a care recipient needs, the more expensive assisted living will be.

Nearly all assisted living facilities will require an assessment prior to, or shortly after, a resident’s move-in date. The purpose of the assessment is to provide each resident with a level of care appropriate for their needs, and to ensure that the assisted living facility can provide that care. Because assisted living is regulated on the state level, the forms used for these assessments will vary from state to state and sometimes even from facility to facility. Assisted living resident assessment forms used in Rhode Island and Oklahoma show that residents are typically evaluated on the following criteria: ^[3]Rhode Island Department of Health. Assisted Living Resident Assessment. Found on the internet at https://health.ri.gov/forms/assessment/AssistedLivingResident.pdf ^[4]Oklahoma State Department of Health. Recommended Assisted Living Resident Assessment Form. Found on the internet at https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/long-term-care-services/forms/ltc-comprehensive-assessment-form-for-al.pdf

• Medications taken and the degree to which the resident needs assistance with medication administration
• Any medical conditions or diagnoses, as well as supports needed for those conditions, such as a continuous positive airway pressure (CPAP) machine for sleep apnea
• Degree to which the resident needs help with ADLs, such as bathing, toileting, and personal hygiene
• Level of physical activity, including the resident’s ability to walk without assistance and transfer to and from bed on their own
• Behavioral information, including cognitive function
• Risk factors, such as violent behavior or wandering outside
• Special diets or preferences

After this evaluation, Carla Payne, a certified life care manager and founder of Aging Care Matters in Wake Forest, North Carolina, shared that a base rate of $2,500 can easily balloon to $5,000 or more per month. “A community may start with a base rate of $2,500 for just the room with meals included,” she said, “but after an assessment by the nurse, the person is deemed to need medication management, which adds money to the base fee. Or the person is incontinent and needs assistance in the bathroom, which again adds money.”

Here’s how those fees break down in two facilities we researched:

• One facility we researched in Lafayette, Colorado, offered a base fee of $4,500 for a one-bedroom apartment and $4,000 for a studio. In addition to the apartment, this fee included Wi-Fi and cable, housekeeping, laundry, and three meals and three snacks per day. This facility then had three levels of care, priced at an additional $700 per month, $1,100 per month, and $1,700 per month. Someone who needed level one care would have minimal needs, such as help with medication management and one or two ADLs. Someone in level three care would need the highest level of care the facility offered, which might include escorts to communal spaces, help with toileting, and transferring from bed to a chair and back again. At this assisted living facility, a resident with a one-bedroom apartment who needed a high level of care could pay as much as $6,200 per month.
• A facility we researched in Grand Rapids, Michigan, had three all-inclusive pricing tiers. Each tier included a studio apartment, Wi-Fi and cable, housekeeping, laundry, three meals and snacks per day, and any personal care services the resident needed. In this facility, the monthly fee for the first tier, or the lowest level of care, was $5,100 per month. The third tier, or the highest level of care, was $6,700 per month.

In most facilities, residents are regularly assessed, and their level of care may change based on that assessment. Older adults and their caregivers should know the cost of assisted living will increase along with the resident’s needs.

Assisted living hidden fees

Before signing a lease with an assisted living facility, be sure you read the contract’s fine print. Gerontologist Christina Peoples, founder and lead educator at GeroWhat?!, shared that overlooking important parts of the assisted living contract, combined with a lack of transparency from staff, can result in residents experiencing “anxiety, discharge for nonpayment, and distrust in staff.” To avoid these issues, read the contract closely and consider having an elder law attorney review it before you sign. Also, ask questions about fees that could increase the monthly assisted living payment.

Community fees

Many assisted living facilities require new residents to pay an initial community fee. This one-time fee, often used to prepare a unit for the next occupant, is usually nonrefundable and can range from $1,000–$5,000. One facility we researched in Columbus, Ohio, asked for a $1,500 community fee. Another facility in Greenville, South Carolina, asked for a $2,500 community fee.

Rent increases

Assisted living facilities often increase rates on an annual basis. Payne estimated annual increases to be between 4% and in some cases as high as 10%. That kind of increase can make a significant difference in your budget. Before signing an agreement with an assisted living facility, ask about annual rent increases.

Fees for increased level of care

Even if a care recipient starts assisted living at the lowest level of care, a person’s needs will usually increase as they age. Events, like unexpected illnesses or falls, can increase the need for care, which will in turn increase your monthly costs. Be sure to ask the facilities you tour about the fees associated with every level of care. Also, if a person’s needs progress to the point the facility can no longer provide the level of care the resident requires, what steps will the facility take to help you find care you need and can afford?

Memory care fees

The National Center for Assisted Living (NCAL) reported that 42% of assisted living residents are living with Alzheimer’s disease or another form of dementia. ^[5]The National Center for Assisted Living. Assisted Living Facts and Figures (Residents). Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx When a person’s dementia progresses to the point they can no longer carry out most ADLs or are at risk of wandering outside the facility, it’s time for memory care. A switch from assisted living to a memory care unit in the same facility can significantly increase monthly fees. For reference, the average monthly cost of memory care is $6,160. ^[6]Dementia Care Central. Alzheimer’s / Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/ That’s about $1,600 more each month than the cost of assisted living alone.

Factors that influence assisted living costs

Where you live, how much care you need, and the type of facility all influence how much you’ll pay for assisted living. To make an accurate estimate of your monthly assisted living costs, include each of the following factors in your calculations.

Size of living quarters

Many assisted living facilities offer apartments in different sizes, such as a studio or a one-bedroom apartment. In general, the smaller your living quarters, the less you’ll pay, except in the case of a shared room, which is usually more affordable than a private apartment.

Level of care

Once assessed by the assisted living staff, a care recipient will be placed in a corresponding level of care. This level of care will determine how much you pay for personal care services each month. Our research shows these fees range from $300 per month for daily medication management or administration to as much as $1,700 per month for help with multiple ADLs.

Amenities

Facilities with several modern amenities, such as fitness centers, spas, or movie theaters, may be more expensive than facilities with fewer amenities. Payne suggested looking beyond aesthetics and focusing, instead, on the quality of the staff and the care they provide. Some of the smaller, more affordable facilities may provide excellent care, even if they’re not as fancy as facilities owned by large companies. Ask, too, about staff turnover.

Geographic location

Where you live in the country plays a role in how much you pay for assisted living. Genworth reported the average monthly cost of assisted living in Alaska is $6,830. In Arkansas, it’s $3,760. Cost also varies within states. For example, the average monthly cost of assisted living in Boston, Massachusetts, is $6,819. In Pittsfield, Massachusetts, on the eastern side of the state, the average monthly cost of assisted living is $2,084. ^[2]Genworth. 2021 Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html

Table 1 Average monthly cost of assisted living by state and selected cities, as of 2021

Source: Genworth 2021 Cost of Care Survey. In some cases, data is only available for one metro area per state.

*District of Columbia added to Delaware and Maryland for cost comparison to nearby metro area.

How to pay for assisted living

The search for assisted living can feel overwhelming, especially when it comes to cost. It’s important to carefully consider the cost of each facility you visit, and then have an honest discussion about how you’ll cover the fees. For planning purposes, it may be helpful to know the average stay in assisted living is about 22 months. ^[5]The National Center for Assisted Living. Assisted Living Facts and Figures (Residents). Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx After that, about 60% of residents transition out of assisted living to a skilled nursing facility.

Personal savings

Many people pay for assisted living using their personal savings. This may include Social Security benefits, 401(k) or IRA accounts, pension payments, or stocks.

Home equity

Proceeds from the sale of your home can also be used to help pay for assisted living. In the event one spouse is staying in the home and the other requires assisted living, assisted living costs can be covered by a reverse mortgage, which allows homeowners to use their own home as security for the loan. ^[9]Consumer Financial Protection Bureau. What is a reverse mortgage? Found on the internet at https://www.consumerfinance.gov/ask-cfpb/what-is-a-reverse-mortgage-en-224/ Before making this kind of financial decision, always get the advice of a trusted financial advisor.

Long-term care insurance

If you have long-term care insurance, you may be reimbursed for some of the cost of assisted living, but it’s important to know the details of your policy. Many have a 90-day elimination period during which the beneficiary has to pay for services out of pocket. If you start the 90-day elimination period the day you move into assisted living, you could be responsible for thousands of dollars in expenses. To save money, Payne recommended using that 90-day out-of-pocket period on less expensive services, like in-home care, prior to moving to an assisted living community.

Veterans benefits

If a care recipient is a veteran or the surviving spouse of a veteran, you may qualify for Veterans Aid and Attendance benefits, which help to reduce the cost of assisted living. These benefits will not cover the cost of room and board, but they will pay for many other services provided to veterans in assisted living facilities, such as medication management and help with ADLs. Check with the Department of Veterans Affairs or use BenefitsCheckUp to explore your options. Additionally, state veteran homes may be an option for those who qualify.

Life insurance benefits and conversions

Some people use life insurance to pay for long-term care, either through life settlements or accelerated death benefits. ^[7]LongTermCare.gov. Using Life Insurance to Pay for Long-term Care. Found on the internet at https://acl.gov/ltc/costs-and-who-pays/who-pays-long-term-care/using-life-insurance-to-pay-for-long-term-care In a life settlement, women over the age of 74 and men over the age of 70 can sell their policy for the cash value of the policy’s death benefit. Be aware, though, that you may not receive the benefit’s full cash value in this kind of arrangement. The same is true for accelerated death benefits, which are tax-free advances on a policy’s death benefit that are capped at 50% of the policy’s full benefit.

Medicare

Medicare will not pay for any form of long-term care. But you can use Medicare to help cover the cost of some goods and services received in assisted living. These include:

• Outpatient health care services, such as home health, and some prescription drug costs
• Physician-ordered physical, occupational, and speech therapy
• Up to 100 days in a skilled nursing facility
• Durable medical equipment (DME), such as walkers, bedside commodes, or shower stools

Medicaid and Medicaid waiver programs

All Medicaid programs have some federal oversight, but states run their own individual Medicaid programs. This means Medicaid eligibility and available services will vary depending on where you live. In most cases, Medicaid will pay for selected services that Medicaid-eligible older adults receive while they are assisted living residents, such as personal care services, case management, transportation to doctor’s appointments, and personal medical alert systems.

While Medicaid itself cannot be used to cover room and board for living expenses, Medicaid combined with waiver programs can be used toward the total amount of assisted living costs in some states. These Medicaid 1915(c) Home & Community-Based Services (HCBS) waivers have broad federal guidelines, and states tailor them to meet the needs of residents in their state. ^[8]Medicaid.gov. Home & Community-Based Services 1915(c). Found on the internet at https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html

Currently, there are 300 HCBS waiver programs across the United States. In North Carolina, a social worker helped Moore start a Medicaid application for his mother and also encouraged him to apply for Special Assistance, a North Carolina Medicaid waiver that can help eligible older adults pay for the cost of assisted living.“Talking to the social worker at our local senior center was really helpful in navigating the Medicaid maze,” Moore said. “It’s a good idea to get an expert to help you through the process.”

Most assisted living facilities are private pay, and it can be hard to find quality assisted living facilities with Medicaid beds. In addition, not all states offer Medicaid waivers that cover the costs of care provided in assisted living communities. It’s a good idea to start your search early and get on waiting lists at facilities that meet your standards.

To get answers about your Medicaid coverage, contact your state’s Medicaid agency, find a Medicaid advisor through your local area agency on aging, or consult BenefitsCheckUp.

Tax deductions for assisted living

You can help reduce overall cost by deducting expenses associated with assisted living on your tax return. ^[10]Internal Revenue Service. Medical, Nursing Home, Special Care Expenses. Found on the internet at https://www.irs.gov/faqs/itemized-deductions-standard-deduction/medical-nursing-home-special-care-expenses/medical-nursing-home-special-care-expenses While the cost of assisted living room and board is not tax deductible, it’s possible to deduct expenses for medical care you or a care recipient receives in an assisted living community.

How do assisted living costs compare to other forms of older adult care?

To help you make an informed decision, it’s helpful to know how the cost of assisted living compares to the cost of other forms of care. Keep in mind the total cost of care could exceed the base cost cited by a company or facility. For example, the cost of a home health aide doesn’t include the cost of an existing mortgage or groceries and daily meals. And while the base cost of assisted living covers room and board, there may be additional fees for personal care services, like help with ADLs.

At an average monthly rate of $9,034 for a private room, nursing homes are more expensive than both assisted living and memory care. Keep in mind Medicaid will cover 100% of the cost of a nursing home for Medicaid-eligible older adults, but this is not the case with assisted living.

Adult day centers, which offer activities and some health support for older adults who need supervised care outside of the home during the day, cost about $1,690 per month. But these community-based programs only run on weekdays, so supplemental care may still be needed on weekends and evenings.

Table 2 Assisted living costs compared to other forms of older adult care

Source: Genworth 2021 Cost of Care Survey and Dementia Care Central

*This number reflects the monthly cost of professional in-home care provided for 44 hours per week.

**This number reflects the cost of memory care in an assisted living facility; nursing homes do not charge more for residents with memory care needs.

Bottom line

When deciding where you want to live as you age, cost is an important factor. Assisted living is regulated on the state level, so the scope of care and corresponding fees will vary depending on where you live. In most cases, the more care you need, the more you will pay for assisted living.

Medicare and Medicaid can be used to pay for some health services received in assisted living, such as physical therapy or personal care services, but neither will pay for the cost of room and board. Medicaid in combination with a state-level Medicaid waiver, where available, will sometimes help older adults to cover the full cost of assisted living. But not all assisted living facilities have Medicaid beds. In this case, private pay is the only option for potential residents.

For some low- and middle-income Americans, the price of assisted living is prohibitive. Older adults and their caregivers should know there are alternatives to assisted living, such as in-home care. Still, assisted living can be a great choice for many older adults.

Waiting lists for assisted living facilities are common, so planning ahead is more important than ever. To ensure access to the best options for you or someone you care for, start your search early and with as much accurate information as possible.

Have questions about this article? Email us at reviewsteam@ncoa.org.

Sources

1. Local Care Reviews Team survey. 1,000 respondents. Conducted using Pollfish. Launched March 2023.
2. 2021 Cost of Care Survey. Genworth. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html.
3. Assisted Living Resident Assessment. Rhode Island Department of Health. Found on the internet at https://health.ri.gov/forms/assessment/AssistedLivingResident.pdf.
4. Recommended Assisted Living Resident Assessment Form. Oklahoma State Department of Health. Found on the internet at https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/long-term-care-services/forms/ltc-comprehensive-assessment-form-for-al.pdf.
5. Assisted Living Facts and Figures (Residents). The National Center for Assisted Living.  Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx.
6. Alzheimer’s / Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Dementia Care Central. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs.
7. Using Life Insurance to Pay for Long-term Care. LongTermCare.gov. Found on the internet at https://acl.gov/ltc/costs-and-who-pays/who-pays-long-term-care/using-life-insurance-to-pay-for-long-term-care.
8. Home & Community-Based Services 1915(c). Medicaid.gov. Found on the internet at https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html.
9. What is a reverse mortgage? Consumer Financial Protection Bureau. Found on the internet at https://www.consumerfinance.gov/ask-cfpb/what-is-a-reverse-mortgage-en-224.
10. Special Care Expenses. Internal Revenue Service. Found on the internet at https://www.irs.gov/faqs/itemized-deductions-standard-deduction/medical-nursing-home-special-care-expenses/medical-nursing-home-special-care-expenses.

Kate Van Dis Author

Kate Van Dis is a health writer in Chapel Hill, North Carolina. She has written for various audiences on health & wellness, education, and aging. Her current focus is on assisted living, home care, and other extra-care housing options for older adults.

Christopher Norman Medical Reviewer

Christopher Norman is a Board-Certified Geriatric Nurse Practitioner and Holistic Nurse. As a nurse’s aide, registered nurse and now nurse practitioner, he has loved working with older adults since 2004.

Kathleen Cameron Reviewer

Kathleen Cameron, BSPharm, MPH, has more than 25 years of experience in the health care field as a pharmacist, researcher, and program director focusing on falls prevention, geriatric pharmacotherapy, mental health, long-term services and supports, and caregiving. Cameron is Senior Director of the NCOA Center for Healthy Aging, where she provides subject matter expertise on health care programmatic and policy related issues and oversees the Modernizing Senior Center Resource Center.